Expandable endoscopic device

ABSTRACT

Provided herein are expandable endoscopic devices. In accordance with certain aspects of an embodiment of the invention, an endoscopic expandable device is disclosed that comprises an expandable jaw at the distal tip, a control wire connected to the jaw, a sheath enclosing the control wire, and a handle connected to the sheath or wire having an actuating trigger. The expandable jaw is configured to allow its delivery in a retracted configuration to a target site within a patient&#39;s body through the working channel of an endoscope, after which the jaw may reconfigure to an expanded configuration that is larger than the retracted configuration. This allows the expandable jaw to be easily delivered to the target site while allowing an operable jaw size that is larger than would be allowed if limited to size of the working channel. The expandable jaw of the endoscopic expandable device may optionally be detachable from the sheath, in which case a jaw release mechanism may also be provided and controlled from the handle. The endoscopic expandable device described herein may, in accordance with certain aspects of the invention, have utility as a clip, and may, in accordance with further aspects of the invention, have utility as forceps. Also disclosed are methods of using the devices identified above.

FIELD OF THE INVENTION

The present invention relates generally to endoscopic devices. Morespecifically, the present invention relates to expandable endoscopicdevices useful as clips and forceps.

BACKGROUND

Endoscopic forceps and clips are routinely used by endoscopists formucosal biopsy and closure of a luminal defect created for therapeuticpurposes or iatrogenically. The endoscopic approach is desirable in manycircumstances because it is minimally invasive. However, the size oftypical endoscopic clips and forceps are limited by the relatively smalldiameter of the working channel of commercially available endoscopes.Conventional biopsy forceps are limited to target areas of approximatelyfive millimeters or less in diameter. The resection of larger tissuesamples requires multiple passages. Conventional endoscopic clips arelimited by the same constraints as conventional endoscopic forceps. Assuch, multiple clips may be needed to close larger defects. This maylead to complications and unnecessarily extends the time it takes toperform a procedure.

Accordingly, there is a need for endoscopic clips and forceps that fitwithin the working channel of a conventional endoscope, yet that areable to expand to a large enough size to fixate large defects, to removelarge tissue samples, or to close mucosal defects in a single passage.

SUMMARY OF THE INVENTION

Provided herein are expandable endoscopic devices. In accordance withcertain aspects of an embodiment of the invention, an endoscopicexpandable device is disclosed that comprises an expandable jaw at thedistal tip, a control wire connected to the jaw, a sheath enclosing thecontrol wire, and a handle connected to the sheath or wire having anactuating trigger. The expandable jaw is configured to allow itsdelivery in a retracted configuration to a target site within apatient's body through the working channel of an endoscope (including,by way of non-limiting example, endoscopes used in urology, ENTapplications, arthroscopy, laparascopic surgical procedures, and thelike), after which the jaw may reconfigure to an expanded configurationthat is larger than the retracted configuration. This allows theexpandable jaw to be easily delivered to the target site while allowingan operable jaw size that is larger than would be allowed if limited tosize of the working channel. The expandable jaw of the endoscopicexpandable device may optionally be detachable from the sheath, in whichcase a jaw release mechanism may also be provided and controlled fromthe handle. The endoscopic expandable device described herein may, inaccordance with certain aspects of the invention, have utility as aclip, and may, in accordance with further aspects of the invention, haveutility as forceps. Also disclosed are methods of using the devicesidentified above.

In accordance with further aspects of an embodiment of the invention, anexpandable endoscopic device is provided having a shaft extending in afirst direction, an expandable grasping jaw assembly positioned at adistal end of the shaft, and a handle at a proximal end of the shaft,wherein the expandable grasping jaw assembly includes a plurality ofgrasping jaws expandable and retractable in a second directionperpendicular to the first direction.

In accordance with still further aspects of an embodiment of theinvention, a method of using an expandable endoscopic device isprovided, including the steps of providing an expandable endoscopicdevice having a shaft extending in a first direction, an expandablegrasping jaw assembly positioned at a distal end of the shaft, and ahandle at a proximal end of the shaft, wherein the expandable graspingjaw assembly includes a plurality of grasping jaws expandable andretractable in a second direction perpendicular to the first direction;moving the expandable endoscopic device to a target site within apatient; expanding the grasping jaw assembly of the expandableendoscopic device to a desired size; closing the grasping jaw assemblyaround tissue at the target site; retracting the grasping jaw assemblyof the expandable endoscopic device to a size smaller than the desiredsize; and removing at least a portion of the expandable endoscopicdevice from the patient.

BRIEF DESCRIPTION OF THE FIGURES

The above and other features, aspects, and advantages of the presentinvention are considered in more detail, in relation to the followingdescription of embodiments thereof shown in the accompanying drawings,in which:

FIG. 1 is a schematic view of an expandable endoscopic device inaccordance with certain aspects of an embodiment of the invention.

FIG. 2 is an exploded perspective view of the working end of theexpandable endoscopic device of FIG. 1 in accordance with certainaspects of an embodiment of the invention.

FIGS. 3a and 3b are an exploded perspective view and a top view,respectively, of the working end of the expandable endoscopic device ofFIG. 1 in accordance with further aspects of an embodiment of theinvention.

FIG. 4 is a flow chart representing an exemplary method for using theexpandable endoscopic device of FIG. 1 as a clip.

FIG. 5 is a flow chart representing an exemplary method for using theexpandable endoscopic device of FIG. 1 as forceps.

FIG. 6 is an exploded perspective view of the working end of theexpandable endoscopic device of FIG. 1 in accordance with furtheraspects of an embodiment of the invention.

FIG. 7 is a close-up view of a torsion spring for use with the workingend of FIG. 6.

FIG. 8 is a close-up view of a first grasping jaw for use with theworking end of FIG. 6.

FIG. 9 is a close-up view of a second grasping jaw for use with theworking end of FIG. 6.

FIG. 10 is a close-up perspective view of the working end of FIG. 6 inan assembled condition.

FIG. 11 is a side view of a cable assembly for use with the expandableendoscopic device of FIG. 1.

FIG. 12 is a perspective view of a handle for use with the expandableendoscopic device of FIG. 1.

DETAILED DESCRIPTION

The invention summarized above may be better understood by referring tothe following description, claims, and accompanying drawings. Thisdescription of an embodiment, set out below to enable one to practice animplementation of the invention, is not intended to limit the preferredembodiment, but to serve as a particular example thereof. Those skilledin the art should appreciate that they may readily use the conceptionand specific embodiments disclosed as a basis for modifying or designingother methods and systems for carrying out the same purposes of thepresent invention. Those skilled in the art should also realize thatsuch equivalent assemblies do not depart from the spirit and scope ofthe invention in its broadest form. Likewise, in the followingdescription, for the purposes of explanation, numerous specific detailsare set forth in order to provide a thorough understanding of thepresent invention. It will be apparent, however, to one skilled in theart that the present invention may be practiced without these specificdetails. In other instances, well-known structures and devices are shownin block diagram form in order to avoid unnecessarily obscuring thepresent invention.

In accordance with certain aspects of an embodiment of the invention,FIG. 1 shows a schematic view of an expandable endoscopic device 100,which may be configured to remove a tissue sample or to close aperforation in a body. Expandable endoscopic device 100 includes anelongated shaft 110 made of generally flexible or pliable material, aworking end 120 at the distal tip, and a handle 130 at the proximal end.Working end 120 may be configured for use as expandable forceps or as anexpandable clip. Expandable endoscopic device 100 also preferablyincludes a control wire 140 extending through an axially rigid andpreferably laterally bendable sheath 150, which in turn extends throughelongated shaft 110. Control wire 140 is attached to the working end 120at the distal tip and to handle 130 at the proximal end, and morepreferably to an actuator in handle 130, as discussed in greater detailbelow. Control wire 140 may slide inside of sheath 150. Control wire 140may be retracted into sheath 150 so that working end 120 may be fully orpartially within sheath 150.

Particularly in those configurations in which working end 120 isconfigured as an expandable clip, the proximal end of medical device 100may comprise a clip release actuator 160 configured to release workingend 120 following placement. Clip release actuator 160 may beincorporated into handle 130 or it may be separate from handle 130. Inthose configurations of expandable endoscopic device 100 in which a cliprelease mechanism is provided, the clip release actuator 160 controls aclip release 170 located at the distal end of sheath 150. In theillustrated embodiment, the clip release 170 is centrally located. Inother examples, there may be more than one clip release point located onthe expandable clip located at the working end 120.

In some examples, the medical device 100 is sized to fit within theworking channel of commercially available endoscopes. In other examples,the medical device 100 may be a stand-alone device. In stand-aloneexamples, the medical device 100 may further comprise one or moreadditional working channels.

FIG. 2 is an exploded perspective view of the working end of expandableendoscopic device 100 in accordance with certain aspects of anembodiment of the invention. An expandable jaw (shown generally at 200)is provided at the distal end of expandable endoscopic device 100, whichexpandable jaw 100 may expand and contract in a generally lineardirection, outward from and perpendicular to a centerline of axiallyrigid, laterally bendable sheath 150, generally in the directionindicated by line 202. Expandable jaw 200 includes a base assembly 210and two or more expansion arms 230. Base 210 of expandable jaw 200 maybe connected to, and optionally detachably connected to, mount 152.Mount 152 is preferably fixed to a head 151 of sheath 150 having aslightly smaller outer diameter than that of sheath 150. The outerdiameter of head 151 is likewise slightly less than the interiordiameter of mount 152, such that mount 152 may be joined to head 151 ofsheath 150 through use of (by way of non-limiting example) adhesive,welding, or such other connection methods as will be apparent to thoseskilled in the art.

A connecting pin 211 may extend across base 210, and likewise throughopenings 153 at a distal end of mount 152. Pin 211 also hingedlyconnects a first arm 212 of base 210 to second arm 213 of base 210,allowing arms 212 and 213 to pivot with respect to one another. Firstmounting arm 214 is attached to and extends distally from first arm 212,and is configured to mount one of expansion arms 230. Likewise, secondmounting arm 215 is attached to and extends distally from second arm213, and is configured to mount the other one of expansion arms 230.Thus, as first arm 212 and second arm 213 are pivoted toward oneanother, first mounting arm 214 and second mounting arm 215 willseparate, in turn opening the jaw 200 formed by expansion arms 230. Atorsion spring (FIG. 7) is preferably provided on an interior of base210 and biases first arm 212 away from second arm 213, in turn biasingfirst mounting arm 214 and second mounting arm 215 (and thus the twoexpansion arms 230) toward one another and into a closed, clampingposition. Alternatively, the spring may be positioned to bias first arm212 toward second arm 213, in turn biasing the expansion arms away fromone another and into an open, non-clamping position.

In order to operate expandable jaw 100 so as to open and close expansionarms 230, and to move expansion arms 230 between their expanded state(shown in FIG. 2) and their contracted state (and vice versa), controlwires 140 extend through sheath 150 and outward from the distal end ofsheath 150 to engage expandable jaw 100. A first set of control wires140 a attach to each of first arm 212 and second arm 213, and a secondset of control wires 140 b attach to each of expansion arms 230. Inthose configurations in which expandable jaw 200 is configured as anexpandable clip, such that the clip is desired to be separable fromsheath 150, control wires 140 are preferably detachable from first arm212, second arm 213, and expansion arms 230, such as through activationof clip release actuator 160 discussed above. Likewise, in suchdetachable configuration, base 210 is preferably separable from mount152, such as by having openings 153 at the bottom of mount 152 open tothe distal end of mount 152 but with an opening width slightly less thanthe outer diameter of connecting pin 211. With this configuration, anoperator may pull elongated shaft 110 away from expandable jaw 200 afterit has been placed with sufficient force to cause connecting pin 211 topass through the distal ends of openings 153, which (after separating ofcontrol wires 140 from expandable jaw 200) will allow sheath 150 andmount 152 to be removed while leaving expandable jaw 200 (in the form ofa clip) in place. Other configurations allowing for the release ofexpandable jaw 200 from sheath 150 and mount 152, such as magneticconnections, frictional engagements, detent assemblies, and the likebetween either mount 152 and expandable jaw 200, or between sheath 150and mount 152, may likewise be used without departing from the spiritand scope of the invention.

As mentioned above, control lines 140 b attach to each of expansion arms230 so as to cause expansion arms 230 to expand and contract, generallyin the direction of arrow 202. FIG. 2 shows expandable jaw 100 in itsexpanded configuration. As control lines 140 b are pulled towards theproximal end of the expandable endoscopic device (as further detailedbelow), expansion arms 230 contract in a scissors-type movement towardfirst mounting arm 214 and second mounting arm 215. In the fullycollapsed or retracted configuration, the maximum length of eachexpansion arm 230 is sufficiently small so that sheath 150, mount 152,and the entire expandable jaw 200 may be initially passed through theendoscopic working channel from outside the patient and to the targetsite, and may likewise be retracted into the endoscopic working channelso as to allow for removal of expandable jaw 200 after its use.

In order to allow expansion arms 230 to so expand and contract,expansion arms 230 may be formed from a plurality of linkages 232attached to one another at pivot joints 240. Pivot joints 240 allowindividual linkages 232 to pivot with respect to one another in adirection that is perpendicular to the direction in which expansion arms230 expand and contract. The particular number and size of linkages 232and pivot joints 240 on a given expandable jaw 200 may vary, dependingupon the desired size and use of the expandable jaw 200. A central,upper pivot joint 240 a is provided as the center pivot joint for eachexpansion arm 230 closest to base 210, and is preferably configured tohold the second set of control wires 140 b. Optionally and as discussedabove, upper pivot joint 240 a may be configured to detachably hold suchsecond set of control wires 140 b. A central, lower pivot joint 240 b islikewise provided as the center pivot joint for each expansion arm 230furthest from base 210. As second set of control wires 140 b are pulledfrom the proximal end of expandable endoscopic device 100, upper pivotjoint 240 a is pulled upward and away from lower pivot joint 240 b, inturn causing expansion arms 230 to retract toward each of first mountingarm 214 and second mounting arm 215. Upper pivot joint 240 a may bebiased toward lower pivot joint 240 b, such as through use of a springmember attached to the two pivot joints, in turn biasing expandable jaw200 toward the expanded state shown in FIG. 2. Alternatively, second setof control wires 140 b may be sufficiently rigid so as to force upperpivot joint 240 a toward lower pivot joint 240 b when second set ofcontrol wires 140 b is pushed toward the distal end of expandableendoscopic device 100.

Optionally, additional control wires may be provided and joined toadditional pivot joints 240 as described above to further aid inexpanding and contracting expansion arms 230. Likewise, additionalcontrol wires may be provided to engage the clip release 170 onexpandable jaw 200 configured as discussed above.

Moreover, expandable arms 230 and joints 240 may optionally beconfigured to allow for retraction into the endoscopic working channelother than as configured above, such as by allowing the ends ofexpansion arms 230 to fold inward toward first mounting arm 214 andsecond mounting arm 215, such as by pivoting about central, upper pivotjoint 240 a so that expansion arms point in a direction parallel tosheath 150.

Expandable jaw 200 may also optionally include teeth 260 attached to aninterior side of expansion arms 230. As shown in the configuration shownin FIG. 2, teeth 260 may extend perpendicularly from the interior faceof expansion arms 230. Teeth 260 may likewise extend outward from theinterior face of expansion arms 230 at various angles, such as (by wayof non-limiting example) about 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°,100°, 110°, 120°, 130°, 140°, 150°, 160°, or 170°. Teeth 260 may extendoutward from the interior face of expansion arms 230 only in a planethat is perpendicular to a plane containing the interior face of eachexpansion arm 230, or may extend at a vertical angle and thus in a planethat is not perpendicular to the plane containing the interior face ofeach expansion arm 230. Teeth 260 may be located in sets of two, witheach corresponding tooth 260 adjacent from one another so that whenexpandable jaw 200 is positioned at its intended site within a patient,each adjacently facing pair of teeth 260 comes together so that suchpair of teeth 260 are touching. Optionally, teeth 260 may also includeadditional elements to provide for additional fixation, including by wayof non-limiting example barbs or hooks. Further, the length and width ofteeth 260 may vary and will depend upon the desired specifications forthe clinician. The shape and orientation of teeth 260 may be uniformthroughout the entire span of expansion arms 230, or some or all maydiffer in shape and/or orientation from one another. Likewise, teeth 260may be eliminated altogether, in which case the interior faces ofexpansion arms 230 are used to secure or grasp the target area of thepatient's anatomy. The interior faces of expansion arms 230 may besmooth or coarse.

An alternative configuration for the expandable jaw of expandableendoscopic device 100 is shown in the perspective exploded view of FIG.3a , in which expandable jaw 300 is provided as a round, and preferablycircular, assembly that radially expands and contracts. While FIG. 3ashows expandable jaw 300 in its retracted configuration, FIG. 3bprovides a top-down view of expandable jaw 300 in its expandedconfiguration. Expandable jaw 300 may be formed of three or morelinkages 332 attached to one another by three or more joints 340. Asshown in FIGS. 3a and 3b , linkages 332 are curved and are pivotablyconnected to one another by joints 340 so as to form a generallycircular shape. Alternatively, linkages 332 may be connected to oneanother so as to form an elliptical or polygonal shape. The curvature ofindividual linkages 332, and the number and location of joints 340, mayvary so as to optimize the expanded configuration of expandable jaw 300for various applications.

As with linearly expandable jaw 200, radially expandable jaw 300 maylikewise be provided a plurality of teeth 360 attached to an interiorface of linkages 332, which again may vary in size and orientation asdescribed above with respect to teeth 260. Likewise, teeth 360 may beeliminated altogether, in which case the interior faces of linkages 332are used to secure or grasp the target area of the patient's anatomy.The interior faces of linkages 332 may be smooth or coarse.

In order to operate radially expandable jaw 300, control wires 140 areagain provided that extend from the distal end of mount 152 (which inturn is positioned at the distal end of sheath 150), which control wires140 are attached to one or more of the upper most (i.e., closest tomount 152) joints 340, such that pulling guide wires 140 toward theproximal end of expandable endoscopic device 100 will result in radiallyexpandable jaw 300 retracting toward the retracted configuration shownin FIG. 3, allowing expandable jaw 300 to be retracted to engage tissueinside of a patient's body, and further retracted into the fullyretracted position of FIG. 3a so that it may pass through the endoscopicworking channel. Radially expandable jaw 300 may optionally be springbiased toward the fully expanded configuration of FIG. 3b , or one ormore of control wires 140 may be sufficiently rigid so that pushing thecontrol wires 140 from the proximal end of expandable endoscopic device100 and toward the distal end will cause expandable jaw 300 to movetoward the expanded configuration of FIG. 3 b.

Optionally, radially expandable jaw 300 may also be separable fromsheath 150 using a release configured as described above with regard tolinearly expandable jaw 200.

Further, when linearly expandable jaw 200 or radially expandable jaw 300is configured for use as forceps, one or more spikes (not shown) may beprovided extending distally from base 210 (in the linearly expandablejaw 200 configuration) or from the distal end of sheath 150 (in theradially expandable jaw 300 configuration). Such spikes are generallyprovided a sharp point at the distal end, but may have a different shapeso long as the spike shape assists with securing the target site. Thelength and diameter of the spike may vary, but the spike is preferablyno larger than what can be housed inside of the arms of the forcepswithout impeding the other moving parts.

FIG. 4 provides a flow chart depicting a first exemplary method forusing an expandable endoscopic device 100 as described above, andparticularly when such expandable endoscopic device 100 is configuredfor use as a clip. In this configuration, the expandable clip may beused to stop acute bleeding and hemostasis in a patient'sgastrointestinal tract. However, this example should be understood asonly one of the many implications for which an expandable endoscopicclip as described herein might be used. It would be understood by thoseof ordinary skill in the art that not all of the steps recited in theflow chart of FIG. 4 would be necessary in order to perform theoperation. One would also recognize that the identified steps may beconducted in a different order without impacting the effectiveness ofthe procedure.

In step 401, the clinician identifies a target in need of hemostaticclipping. Next, in step 402, an expandable endoscopic clip configured asabove is moved to the target site. With regard to certain aspects of anexemplary embodiment, the expandable endoscopic clip is entered througha working channel of an endoscope. In step 403, the clip is expanded tothe necessary size. With regard to further aspects of an exemplaryembodiment, the size of the clip is expanded, such as (by way ofnon-limiting example) by pushing control wires 140 toward the distal endof sheath 150. In step 404, the expandable endoscopic clip is closed tobring the jaws of the device together. With regard to still furtheraspects of an exemplary embodiment, the clip is closed by pulling thecontrol wires 140 toward the proximal end of the expandable endoscopicdevice 100. Optionally, once the clip has secured the trauma site, instep 405 the expandable endoscopic clip is released by the clip releasemechanism, and at step 406 the remaining assembly is removed from theendoscope.

Likewise, FIG. 5 provides a flow chart depicting a first exemplarymethod for using an expandable endoscopic device 100 as described above,and particularly when such expandable endoscopic device 100 isconfigured for use as forceps. Once again, it would be understood bythose of ordinary skill in the art that not all of the steps recited inthe flow chart of FIG. 5 would be necessary to perform the operation.One would also recognize that the identified steps may be conducted in adifferent order without impacting the effectiveness of the procedure.

In step 501, the clinician identifies a trauma site requiringapplication of the expandable forceps. Next, in step 502, the expandableforceps are moved to the target site. With regard to certain aspects ofan exemplary embodiment, the expandable forceps are entered through aworking channel of an endoscope. In step 503, the expandable forceps areexpanded to the necessary size. With regard to further aspects of anexemplary embodiment, the size of the forceps are expanded, such as (byway of non-limiting example) by pushing control wires 140 toward thedistal end of sheath 150. In step 504, the expandable forceps are closedto bring the jaws of the device together, such as by pulling the controlwires 140 toward the proximal end of the expandable endoscopic device100. In step 505, the expandable forceps, sheath 150, and the remainingassembly is removed from the patient by the clinician.

FIG. 6 is an exploded perspective view of the working end of expandableendoscopic device 100 in accordance with still further aspects of anembodiment of the invention. An expandable jaw (shown generally at 600)is provided at the distal end of expandable endoscopic device 100, whichexpandable jaw 600 may expand and contract in a generally lineardirection, outward from and perpendicular to a centerline of axiallyrigid, laterally bendable sheath 150, generally in the directionindicated by line 202. Expandable jaw 600 includes first expansion arm602 and second expansion arm 604, each of which are connected to, andoptionally detachably connected to, mount 152, which in turn ispreferably fixed to head 151 of sheath 150 as described above.

A connecting pin 611 may extend through openings 153 at a distal end ofmount 152. Connecting pin 611 may have flanged outer walls 612 that,when assembled in mount 152, rest against an exterior wall of mount 152to hold connecting pin 611 in place. Pin 611 also hingedly connects afirst arm 614 of first expansion arm 602 to second arm 615 of secondexpansion arm 604, and both expansion arms 602 and 604 to mount 152,allowing first expansion arm 602 and second expansion arm 604 to pivotwith respect to one another. A torsional spring 700 (shown in FIG. 7) ispreferably mounted around connecting pin 611 so that the arms 702 oftorsional spring 700 rest against the interior faces of first arm 614and second arm 615, in turn biasing first arm 614 preferably away fromsecond arm 615, and thus biasing first expansion arm 602 away fromsecond expansion arm 603 into an open-jaw position.

Mounted at a distal end of each of first arm 614 and second arm 615 arelinearly expanding grasper jaws 630, each of which extend outward fromthe distal end of each of first arm 614 and second arm 615. Each grasperjaw 630 is preferably formed of superelastic nitinol, a memory metalcapable of deforming and readily returning to its intended shape afterremoval of the deforming force. Each segment of grasper jaws 630 isjoined at a first edge 631 to the base of its respective arm 614 or 615,and extends outward from such arm 614 or 615. Approximately midwaybetween first edge 631 and an outer edge 632 is a bend 633, such that inthe natural (i.e., non-stressed) configuration, each grasper jaw 630extends initially upward as it extends away from arm 614 or 615 until itreaches bend 633, at which point it turns downward as it extends out toouter edge 632. Bend 633 provides a collapsing point for each segment ofgrasper jaws 630, such that as the outer edges 632 are pulled towardarms 614 or 615 (as discussed in greater detail below), each segment ofgrasper jaws 630 will fold along such bend 633, allowing grasper jaws630 to retract toward arms 614 and 615 so as to achieve a maximum lengththat will allow it to pass through the endoscopic working channel sothat expandable jaw 600 may be both moved to the target site fromoutside the patient, and ultimately removed from the patient after theparticular operation is completed.

FIG. 8 provides various close-up views of first expansion arm 602, andFIG. 9 provides various close-up views of second expansion arm 604.

With particular reference to FIG. 8, first expansion arm 602 includesfirst arm 614 having a head portion 616 with openings 616 a extendingacross the head portion 616 to receive connecting pin 611. First arm 614has a planar back wall 617 and side walls 618. An interior edge 619 ofside walls 618 is provided a series of gripping teeth configured to matewith complementary teeth on the interior edges 623 of side walls 622 ofsecond expansion arm 604 when the two expansion arms 602 and 604 arebrought together into a closed, clamping configuration. Grasper jaws 630are joined to the bottom edge of first arm 614 at the base of each sidewall 618, and as shown in the front view of first expansion arm 602 ofFIG. 8, may initially extend upward from the base of each side wall 618at an angle of, for example, 75°, and may turn downward at bend 633 atan angle of, for example, 30°. An interior edge of each grasper jaw 630is provided a series of gripping teeth 634 configured to mate withcomplementary teeth 635 on the interior edges of grasper jaws 630 onsecond expansion arm 604 (FIG. 9).

A plurality of openings 640, 641, and 642 are provided for receivingcontrol wires 140 therethrough for manipulating first expansion arm 602.More particularly, an opening 640 is provided in each side wall 618through which a first control wire 140 b may pass to engage the adjacentgrasper jaw 630. Likewise, another opening 641 is positioned through thefirst segment of each grasper jaw 630 that is adjacent each side wall618, through which the control wire 140 b that has been passed throughopening 640 may be threaded. Finally, an opening 642 is provided in theouter segment of each grasper jaw 630, which may receive the end of thecontrol wire 140 b that has been passed through openings 640 and 641.Such control wire 140 b is fixed to opening 642, such that pulling onthat control wire 140 b toward the proximal end of expandable endoscopicdevice 100 will result in retraction of grasper jaws 630 towards firstarm 614, as discussed further below. Additionally, an opening 643 isprovided in back wall 617 of first arm 614, to which is joined aseparate control wire 140 a which may be pulled toward the proximal endof expandable endoscopic device 100 to cause pivoting of first expansionarm 602 toward second expansion arm 604 and into a closed, clampingconfiguration.

Likewise, with particular reference to FIG. 9, second expansion arm 604includes second arm 615 having a head portion 620 with openings 620 aextending across the head portion 620 to receive connecting pin 611.Openings 620 a align with opening 616 a of first expansion arm 602 whenthe two expansion arms are assembled onto mount 152. Likewise, headportion 620 is slightly larger than head portion 616 of first expansionarm 602, such that head portion 616 of first expansion arm 602 may fitinside of head portion 620 of second expansion arm 604. Second arm 615has a planar back wall 621 and side walls 622. An interior edge 623 ofside walls 622 is provided a series of gripping teeth configured to matewith complementary teeth on the interior edges 619 of side walls 618 offirst expansion arm 602 when the two expansion arms 602 and 604 arebrought together into a closed, clamping configuration. Grasper jaws 630are joined to the bottom edge of second arm 615 at the base of each sidewall 622, and as shown in the front view of second expansion arm 604 ofFIG. 9, may initially extend upward from the base of each side wall 622at an angle of, for example, 75°, and may turn downward at bend 633 atan angle of, for example, 30°. While such angles may vary, it ispreferable for the profiles of grasper jaws 630 on each of firstexpansion arm 602 and second expansion arm 604 to match so as to be ableto form a tight, closed, clamping configuration. An interior edge ofeach grasper jaw 630 on second expansion arm 604 is likewise provided aseries of gripping teeth 635 configured to mate with the complementaryteeth 634 on the interior edges of grasper jaws 630 on second expansionarm 604 (FIG. 9). Additionally, an oversized tooth 636 or otherprojection is preferably provided on an outermost edge of each grasperjaw 630 of second extension arm 604, which is configured to help guidegrasper jaws 630 of first extension arm 602 into proper engagement withgrasper jaws 630 of second expansion arm 604.

As with first expansion arm 602, a plurality of openings 640, 641, and642 are provided for receiving control wires 140 therethrough formanipulating second expansion arm 604. More particularly, an opening 640is provided in each side wall 622 through which a first control wire 140b may pass to engage the adjacent grasper jaw 630. Likewise, anotheropening 641 is positioned through the first segment of each grasper jaw630 that is adjacent each side wall 622, through which the control wire140 b that has been passed through opening 640 may be threaded. Finally,an opening 642 is provided in the outer segment of each grasper jaw 630,which may receive the end of the control wire 140 b that has been passedthrough openings 640 and 641. Such control wire 140 b is fixed toopening 642, such that pulling on that control wire 140 b toward theproximal end of expandable endoscopic device 100 will result inretraction of grasper jaws 630 towards second arm 615, as discussedfurther below. Additionally, an opening 643 is provided in back wall 621of second arm 615, to which is joined a separate control wire 140 awhich may be pulled toward the proximal end of expandable endoscopicdevice 100 to cause pivoting of second expansion arm 604 toward firstexpansion arm 602 and into a closed, clamping configuration.

FIG. 10 provides a close-up perspective view of expandable jaw 600,including control wires 140 positioned to manipulate first expansion arm602 and second expansion arm 604 as described above. Each control wire140 may be joined to its respective opening 642, 643 by way of adhesivebonding, such as by way of non-limiting example through use ofcyanoacrylate adhesive, although other forms of bonding control wires140 to first and second expansion arm 602 and 604 will be readilyapparent to those of ordinary skill in the art. In order to operateexpandable jaw 600 so as to open and close expansion arms 602 and 604,and to move grasper jaws 630 between their expanded state (shown in FIG.10) and their contracted state, control wires 140 extend through sheath150 and outward from the distal end of sheath 150 and mount 152 toengage expandable jaw 600. A first set of control wires 140 a attach toeach of first arm 614 and second arm 615, and a second set of controlwires 140 b attach to each of grasper jaws 630 as described above.

As control lines 140 b are pulled towards the proximal end of theexpandable endoscopic device (as further detailed below), grasper jaws630 fold inward at bend 633 toward first arm 614 and second arm 615. Inthe fully collapsed or retracted configuration, the maximum length ofeach grasper jaw 630 is sufficiently small so that sheath 150, mount152, and the entire expandable jaw 600 may be retracted into theendoscopic working channel so as to allow for removal of expandable jaw600 after its use.

As grasper jaws 630 are preferably formed of a memory metal such asnitinol, grasper jaws 630 may be initially folded into their collapsedor retracted position when initially placed within the endoscopicworking channel and/or elongated shaft 110, and they will automaticallyexpand to the open configuration shown in FIG. 10 when they exit theendoscopic working channel and/or elongated shaft 110 (i.e., when theconstraining force on the outer edges of grasper jaws 630 is removed),thus easily allowing delivery of expandable jaw 600 to its intendedsight through the endoscopic working channel.

Moreover, and again as a result of grasper jaws 630 being formed of amemory metal such as nitinol, expandable jaw 600 may still be removedthrough an endoscopic working channel even if control wires 140 b arenot provided or are damaged or inadvertently detached during use. Moreparticularly, as sheath 150 and mounts 152 are retracted and pulled intothe endoscopic working channel, the interior walls of the channel willpress against grasper jaws 630, pushing them forward (bending them aboutedge 631) and thus still allowing full retraction of the expandable jaw600 into and through the endoscopic working channel after its use.

FIG. 11 is a side view of an exemplary cable system for interconnectingthe working end of expandable endoscopic device 100 to handle 130. Asshown in FIG. 11, such cable system preferably includes a handleattachment section 700 which may be used to affix the cable assembly tohandle 130 (as discussed in further detail below), axially rigid,laterally bendable sheath 150, and elongated shaft 110. Elongated shaft110 may comprise an FDA-compliant, heat-shrink, acrylated olefinmaterial surrounding sheath 150. Likewise, sheath 150 is preferably inthe form of a tightly wound, stainless steel spring that has sufficientstiffness to provide a guide channel in which guide wires 140 may movewithout binding, sufficient compressive axial rigidity so that it maypush the working end of expandable endoscopic device through theendoscopic working channel and into engagement with the intended tissuewithin a patient's body, and at least some laterally bending flexibilityto allow for positioning and movement through the endoscopic workingchannel.

FIG. 12 is a perspective view of an exemplary handle 130 for use withthe expandable endoscopic device 100. Handle 130 includes a cablereceiver 800 that receives handle attachment section 700 of theinterconnecting cable system of FIG. 11 and fixedly attaches handleattachment section 700 to cable receive 800, such as by crimping,adhesive, welding, or such other attachment mechanisms as will occur tothose of ordinary skill in the art. Control wires 140 extend from theupper end of handle attachment section 700 and are fixedly attached toone of actuator rings 810 or 820, each of which are laterally movablealong a shaft 802 of handle 130. For example, control wires 140 a, whichengage the jaw clamping function at the working end 120 of expandableendoscopic device 120, may be joined to first actuator ring 810, such asby clamping the control wires 140 a on an interior of first actuatorring 810 with a set screw 812. Likewise, control wires 140 b, whichengage the folding/retracting function at the working end 120 ofexpandable endoscopic device 120, may be joined to second actuator ring820, such as by clamping the control wires 140 b on an interior ofsecond actuator ring 820 with a set screw 822. In this configuration,first actuator ring 810 may be grasped, with an operator placing theirthumb through thumb ring 804 and engaging first actuator ring 810 with,for example, their index and middle fingers, pulling first actuator ring810 toward thumb ring 804 to close the clamping jaws at the working end120 and in turn grab the intended tissue at the target site within thepatient and hold that tissue during whatever operation is beingperformed. After the operation is completed, the operator may thenengage second actuator ring 820 in similar manner, drawing it upwardtoward first actuator ring 810 and thumb ring 804, which in turn willcause the expandable jaws at the working end 120 to retract inward to amaximum length that will allow their passage through the endoscopicworking channel. A hinged spring lock 806 may be provided which ishingedly connected to shaft 802 at a lower end of shaft 802, whichspring lock 806 may be flipped upward to engage the bottom face ofsecond actuator ring 820 when it is in its fully retracted position.This will maintain the working end 120 in its retracted position,allowing easy removal of the entire assembly once the medical procedurehas been completed.

Optionally, a single actuator ring 810 may be provided when working end120 is configured having grasper jaws 630 formed of a memory metal, suchas nitinol, as the working end may fold to allow its withdrawal throughthe endoscopic working channel simply as a result of its contact withthe working channel as described above.

The example embodiments of the expandable endoscopic device describedherein may be used for a number of different implications. Whenconfigured for use as an expandable clip, the expandable endoscopicdevice described herein may be used to treat acute bleeding andhemostasis. The expandable clip may also be used to close mucosaldefects following endoscopic procedures such as, for example, anendoscopic submucosal dissection, or an endoscopic mucosal resection.The expandable clip may also be used to close openings of full thicknesswall closure following procedures such as, for example, laparoscopicprocedures, percutaneous endoscopic jejunostomy, and percutaneousendoscopic gastrostomy, in various systems including thegastrointestinal, genitourinary, and respiratory systems.

Likewise, when configured for use as expandable forceps, the expandableendoscopic device described herein may be used to obtain tissue biopsiesfrom the gastrointestinal, genitourinary, and respiratory tracts. Theexpandable forceps may also be used to perform a polypectomy, anendoscopic mucosal resection, or an endoscopic submucosal dissection.

One having ordinary skill in the art would recognize other potentialuses for the various embodiments of the device described herein. Itshould be understood that these uses do not deviate from the broaderspirit and scope of this invention. The specific dimensions of thedevice will depend on the implication for which it is being used. Theshape and size of the expandable endoscopic device and its componentparts will depend, in part, on the size and orientation of the targetsite. These parameters will control the size and design of the workingparts. The device may be designed for a single use or it may bereusable.

In the foregoing specification, the invention has been described withreference to specific embodiments thereof. It will, however, be evidentthat various modifications and changes may be made thereto withoutdeparting from the broader spirit and scope of the invention. Thespecification and drawings are, accordingly, to be regarded in anillustrative rather than a restrictive sense. Throughout thisspecification and the claims, unless the context requires otherwise, theword “comprise” and its variations, such as “comprises” and“comprising,” will be understood to imply the inclusion of a stateditem, element or step or group of items, elements or steps but not theexclusion of any other item, element or step or group of items, elementsor steps. Furthermore, the indefinite article “a” or “an” is meant toindicate one or more of the item, element or step modified by thearticle.

What is claimed is:
 1. An expandable endoscopic device, comprising: ashaft extending in a first direction; an expandable grasping jawassembly positioned at a distal end of said shaft; and a handle at aproximal end of said shaft; wherein said expandable grasping jawassembly further comprises a plurality of grasping jaws expandable andretractable in a second direction perpendicular to said first direction.2. The expandable endoscopic device of claim 1, wherein said handle isoperable to close said grasping jaws toward one another.
 3. Theexpandable endoscopic device of claim 1, wherein said grasping jaws areformed of nitinol.
 4. The expandable endoscopic device of claim 1,wherein said grasping jaws are automatically expandable to a deployedcondition in which said grasping jaws extend in said second direction toassume a deployed jaw length.
 5. The expandable endoscopic device ofclaim 4, wherein said grasping jaws are retractable to a retractedposition in which said grasping jaws have a retracted length that isless than said deployed jaw length.
 6. The expandable endoscopic deviceof claim of claim 5, wherein said retracted length is sufficiently smallto allow passage of said jaw assembly through a working channel of anendoscope through which said shaft extends.
 7. The expandable endoscopicdevice of claim 6, wherein said deployed jaw length is too large toallow passage of said jaw assembly through a working channel of anendoscope through which said shaft extends without deformation of saidjaw assembly.
 8. The expandable endoscopic device of claim 1, whereinsaid grasping jaws further comprise a first grasping jaw pivotablymounted to a second grasping jaw at the distal end of said shaft.
 9. Theexpandable endoscopic device of claim 8, wherein said first grasping jawfurther comprises a first arm pivotably mounted to said distal end ofsaid shaft, a first grasper jaw segment extending outward from a side ofsaid first arm, and a second grasper jaw segment extending outward fromanother side of said first arm.
 10. The expandable endoscopic device ofclaim 9, wherein each of said first grasper jaw segment and said secondgrasper jaw segment is bendable at a point at which each of said firstgrasper jaw segment and said second grasper jaw segment connects to saidfirst arm.
 11. The expandable endoscopic device of claim 9, wherein eachof said first grasper jaw segment and said second grasper jaw segment isretractable toward said first arm.
 12. The expandable endoscopic deviceof claim 11, wherein each of said first grasper jaw segment and saidsecond grasper jaw segment is foldable inward toward said first arm. 13.The expandable endoscopic device of claim 12, further comprising atleast one control wire extending from said handle, through said shaft,and to each of said first and second grasper jaws, wherein pulling saidat least one control wire toward said handle causes each of said firstand second grasper jaws to fold inward toward said first arm.
 14. Theexpandable endoscopic device of claim 9, wherein said first grasper jawsegment and said second grasper jaw segment each have an interior facefacing said second jaw, and each said interior face further comprisesserrated teeth along each said interior face.
 15. The expandableendoscopic device of claim 14, wherein said teeth are configured to matewith complementary teeth on said second grasping jaw.
 16. The expandableendoscopic device of claim 1, wherein said grasping jaw assembly isdetachable from said shaft.
 17. A method of using an expandableendoscopic device, comprising: providing an expandable endoscopic devicecomprising: a shaft extending in a first direction; an expandablegrasping jaw assembly positioned at a distal end of said shaft; and ahandle at a proximal end of said shaft; wherein said expandable graspingjaw assembly further comprises a plurality of grasping jaws expandableand retractable in a second direction perpendicular to said firstdirection; moving said expandable endoscopic device to a target sitewithin a patient; expanding said grasping jaw assembly of saidexpandable endoscopic device to a desired size; closing said graspingjaw assembly around tissue at said target site; retracting said graspingjaw assembly of said expandable endoscopic device to a size smaller thansaid desired size; and removing at least a portion of said expandableendoscopic device from said patient.
 18. The method of claim 17, whereinsaid step of moving said expandable endoscopic device further comprisesmoving said expandable endoscopic device through a working channel of anendoscope.
 19. The method of claim 18, wherein said step of expandingsaid grasping jaw assembly further comprises expanding said grasping jawto a length dimension that is greater than a maximum interior diameterof said working channel of said endoscope.